Today’s guest post is from Amy, who recently delivered a beautiful baby girl named ‘Iva in Nuku’alofa’s public hospital.  I asked if she would be willing to share her very unique story, and happily, she has agreed to do so!  So without further ado, here is Amy’s post.

March 27, 2013

I initially came to Tonga in 2003 as a Peace Corps Volunteer, and stayed in the country for 4 years. During that time, I met Toni, a Tongan guy, who eventually became my husband in 2011. We lived in the States for a few years between 2008 – 2011, then returned to live in Tonga in early 2012. We got pregnant in July 2012 and thus the story begins:

Before even coming back to Tonga and getting pregnant, I had already been thinking that I would return to the States to give birth… whenever that futuristic time would come. I had been to the hospital in Tonga while I was a Peace Corps Volunteer, and I’d rather not subject myself, or my future baby, to the dingy, dilapidated, decrepit state that I remembered it. However, upon returning to Tonga & then discovering that I was pregnant, I also re-discovered Vaiola Hospital, which had been completely rebuilt with foreign aid money, and it just so happened that the maternity ward was the most recently finished wing of the new facility!

Early in my pregnancy I got a tour of the new ward. There are about 6 delivery rooms in total, all of them off of one central room with a wooden desk in the center strewn with files, a.k.a. the nurse’s station. The delivery rooms themselves were a bit daunting with their rickety looking delivery tables; some of which had a foam pad on top of for extra comfort; some had both, one or no foot stirrups in what appeared to be working condition. Each room had a curtain in the doorway waving in the breeze, which seemed like a pretty insubstantial privacy (and sound) barrier. But what stuck out the most to me at the time was the red and white striped “tarp” that draped the bed and drained into a bucket on the floor. Hummm…. Utilitarian & functional, I suppose. I’ve never seen a delivery room in America with my own two eyes, but I thought that this Tongan version was… ahhhh… very basic yet sufficient. I also had a peak at the recovery rooms. There were two options: a shared room or a private room. The shared “rooms” were basically a long hallway with spaces divided by curtains, 2 beds per section. The private rooms were actual rooms with a single bed, 2 side tables, a wall-mounted sink, and one plastic stacking chair. After taking this all in and weighing the pros & cons of delivering my baby in Tonga vs. America, I thought to myself “OK, women give birth here all the time. I can do this here too!” And so the decision was made, as long as my pregnancy progressed healthily & normally with no foreseen complications, I would give birth in Tonga!

Fast-forward about 9 months, during which a smooth & easy pregnancy progressed, with an anticipated due date of March 17th:

On Sunday, March 10th, 2013 at around 11 in the morning, I started feeling some minor lower abdominal & back pain during the first little bit of what I thought were just more pre-labor contractions. My belly was tight to the touch for sometimes 2 or 3 minutes or more, which I had been feeling for the past several weeks, but the additional light pain was just for the first 20-30 seconds. This went on pretty much all day, the pain was light to moderate, so I didn’t think much of it, especially because I wasn’t showing any other positive signs of true labor besides restlessness. I was convinced that it was just strong Braxton-Hicks pre-labor contractions, and the real thing would start relatively soon. I was even timing them and they seemed irregular. On a side note, the doctor who I had been seeing privately at a clinic was out of the country this week. However, he did advise me to go to the hospital when I started feeling pain, so just to be on the safe side, Toni and I headed there at 9:30 pm on Sunday night.

We were expecting to arrive at the hospital, get evaluated, then get sent home because this was merely pre-labor; so we didn’t even bring our overnight bags! At about 10:30 pm, the doctor on-call gave me a vaginal exam & confirmed that I was indeed in real labor… 5 cm dilated already! Wow, that came as a surprise, so Toni ran home to get the bags that I had set out “just in case”! The distance from our house to the hospital is only a couple of miles, so in the meantime, the doc gave me the option to either “augment” the labor (get a shot to speed it up and get it over with quickly) or just let it progress naturally. I chose natural, so they instead gave me a shot of minor sedative to relax me between contractions to maintain my energy level, thinking that labor would last all night and well into the morning. At that point, I got hooked up to the external fetal monitor to read baby’s heart rate, just to make sure things were OK. The heart rate was actually low… it should range between 120 – 160, but it was mainly between 100 – 120, and occasionally dipping below 100. The midwife suspected that it was low because baby was hungry in there, so they hooked me up to an IV with a saline solution drip, which did raise and maintain the heart rate. Since I was hooked up to both the IV & fetal monitor, I didn’t really move around much, but I was actually quite content lying on my side…. Toni would vigorously massage my lower back during contractions as they got stronger, so it was a good position for that. 

The only thing that I didn’t have prepared in my hospital bags were my adult diapers, which the doctor had pre-advised I bring along. I was putting off buying them because I was embarrassed; and I was planning to bite the bullet and get them on Monday… since my due date wasn’t actually until the following Sunday! I told the midwife that I had a bunch of super-heavy duty pads, but she still strongly suggested diapers. So at mid-night, when the little corner-stores open after being closed all day on Sunday, Toni ran across the street to get a few. When he got back, the doctor promptly broke my water and I got strapped into my first diaper to catch the residual amniotic fluid. Soon after my water was broken, things really picked up quickly. The contractions got a lot stronger & more frequent; most of the pain was felt in my back. All of my focus went to my breathing patterns, and before I knew it I suddenly felt the natural urge to PUUUUUUUUSH! 

I got into position. Toni was at my side supporting my head with a mound of pillows since the delivery table was flat. My legs were up in the old-fashion stirrups (I was lucky enough to get a bed that both were functioning!). I had 3 or 4 more contractions worth of pushing and I felt the baby in the birth canal, then I could distinctly feel the crowing. Before I knew it, baby popped out at 1:38 am on Monday. The first thing I saw was HER little vagina… and I said with a big grin “It’s a GIRL!!” (We chose not to find out the gender ahead of time). It’s hard to put into words, but the feeling that came over me as soon as I saw her was pure amazement! All the pain I had just been through disappeared and not much else crossed my mind, I was just in this state of utter amazement that this little being is here and that she’s ours! All 7lbs-11 oz of her. Welcome to the world ‘Iva Litia Minoneti Halapua!

The only downside of delivery was that the midwife did give me a little snippety-snip down there. I probably could have stretched more with a bit of time. Although my doctor reassured me early on that an episiotomy is only performed when necessary, I suspect that the general mentality in Tonga is that it is necessary for everyone, especially a woman’s first child.  Maybe things would have been different if my doctor was there, but there’s no looking back now. In hindsight, the most important thing is that ‘Iva made her way out and is healthy. The on-call doctor wasn’t even present during the actual birth… he did the initial vaginal exam, broke the water and then I didn’t see him again, which is totally fine as I felt quite comfortable with the midwife in charge. Toni actually knew her from his school days, and she even stayed past the end of her 12:00am shift, which was very generous of her. Toni took some root crop & fish over to her house after we were discharged as a thank you from ‘Iva!

So back to the delivery room; the midwife placed ‘Iva in my arms directly after birth while the placenta was born, which didn’t require much effort on my part. They stitched me up, which I couldn’t really feel because the area was already acclimated to the pain and my focus was now on ‘Iva. Then they helped get me into a second diaper, cut the cord & gave ‘Iva her first bath. We were told to hang tight there in the delivery room until I had to pee, then we could be transferred to the recovery room. I think we were there about 1 1/2 hours or so and I was still in this state of wonder while Toni and I passed ‘Iva back & forth to each other. When I did finally have to pee, I notified the nurse and she asked if I needed a wheelchair & assistance in the bathroom… but I was OK to walk & wipe myself, thank you very much! 

The hospital stay was fine. We were actually pretty comfortable there, relatively speaking. We sprung for a private room; as opposed to a shared room. Since I’m a foreigner, we were getting charged $100+ per night, rather than the $30 Tongan rate. We actually raised a stink about that silly rule based on principle because ‘Iva is half Tongan, so our hospital bill ended up being $60 for the 2 nights we were there when all said and done. Yes, 60 bucks; No outrageous doctor’s fee, no hidden fees, no insurance to deal with.  What a deal!

Anyway, we basically had to bring everything we needed to the hospital, so I’m glad I didn’t pack light! That included sheets & a blanket for the bed, several pillows, a night-gown for myself (no hospital gowns provided), diapers for myself & baby, receiving blankets, clothes, toiletries, towel for showering… and everything else that baby, Toni or I might need. I even threw in a roll of toilet paper last minute, which I was VERY glad I had since the hospitals TP was not refilled very often. We also brought a cooler of snacks including milk, juice, granola, trail mix & fruit. However, I failed to bring the baby-shampoo… who knew… so the midwife was nice enough to dig into the hospitals stock for ‘Iva’s first bath!

Toni stayed with ‘Iva and I the whole time in the hospital; we slept head to toe in the single bed, with ‘Iva nestled by my side. Generally, the babies stay with the mom during the entire hospital stay… no nursery to be carted off to. Toni ran home a couple times to refill our food supplies, including making a crock-pot of soup, so I didn’t eat any of the hospital-provided food, which didn’t look very appetizing. (Breakfast was 3 slices of white bread with butter; Lunch was some kind of unidentifiable soup thickened with flour; Dinner was beef chunks with some overcooked veggies). We had a couple of visitors but were not inundated, which was nice. We were discharged from the hospital on Tuesday morning after ‘Iva was cleared. Funny enough, her birth certificate is actually not done yet, because that official only works specific days, so we have to go back this week to document her birth! Only in Tonga!

I have to say, the whole experience of giving birth in Tonga was a good one and I’m glad that we took the plunge. However, I was not impressed in one major area… the passage of information/knowledge/advice on what to expect & how to “deal” with pregnancy, labor/delivery, baby-care and the transition into motherhood. I guess it’s the Tongan-way for an experienced family member to pass all this knowledge rather than the doctors & nurses; and forget about pre-natal classes! All I’m going to say is that I’m very thankful that I had plenty of books to educate myself on pregnancy, coping with labor/delivery, postpartum recovery, baby-care, breast feeding, transition into motherhood, and just how babies are, etc… along with advice from my mom, doulas that I know, and friends that have gone through it already.

All in all, I truly value experiencing my pregnancy, labor and delivery here in Tonga, and I wouldn’t change anything about it… especially the final product, the gift of our sweet daughter ‘Iva!

UPDATE: Amy is now the mother of two beautiful children, and she blogs about her life in Tonga at https://halapuahome.wordpress.com/!